Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XF0002X | Feeding, Eating & Swallowing | 007519 | OH |
NPI | 1114208048 |
---|---|
Provider Name | Mary K Henthorn |
First Address | Florence, KY 41042-8928 |
Second Address | Florence, KY 41042-8928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2011 |
Last Update Date | 15/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2187155 | (05) | OH |